Retropharyngeal Lymph Node Metastasis Diagnosed by Magnetic Resonance Imaging in Hypopharyngeal Carcinoma: A Retrospective Analysis From Chinese Multi-Center Data.

Changming An,Susheng Miao,Zhengjiang Li,Ying Sun,Shaoyan Liu,Ye Zhang,Xiaoduo Yu,Junlin Yi,Xiwei Zhang,Lili Xia

doi:10.3389/fonc.2021.649540

Abstract

BackgroundTo assess the prevalence, risk factors and prognostic significance of retropharyngeal lymph node (RPLN) metastasis diagnosed by magnetic resonance imaging (MRI) in patients with hypopharyngeal squamous cell carcinoma (HPSCC).Methods259 patients from three cancer institutions in China from Jan 2010 to Dec 2018 were analyzed, retrospectively. All the patients had been given pre-treatment magnetic resonance imaging (MRI) of head and neck and were then treated with definitive radiotherapy with or without chemotherapy. Pretreatment diagnostic MRIs were reviewed by a dedicated head and neck radiologist, for the presence or absence of radiographically positive RPLN, cervical LN and tumor invasion.Demographic variables were analysed by descriptive statistics using SPSS 20.0. Predictors of the presence of RPLN and its prognostic significance were examined.ResultsRPLN metastasis was discovered in 44 patients (17%). Logistic analysis showed that posterior pharyngeal wall (PPW) primary tumor; PPW invasion; N2-3; multiple cervical lymph node (LN) involvement (>2 LNs) were associated with RPLN metastasis, with metastasis rates 37%, 30%, 31% and 33% respectively. Patients with RPLN metastasis had a significantly reduced 5-year overall survival (OS) and disease-free survival (DFS) compared to the non-RPLN metastasis group (OS 28% vs. 48%, p=0.001; DFS 25% vs. 41%, p=0.040).ConclusionsRPLN metastasis was not uncommon in HPSCC patients. Risk factors were: PPW primary tumor, PPW invasion and cervical LN status. RPLN metastasis is a poor prognosticator for survival.

Highlights

Among head and neck cancers, hypopharyngeal carcinoma (HPC) is most often detected at an advanced stage with poor prognosis, having 5 year survival rates of 31-47% [1,2,3]
We investigated the treatment results in HPC from three centers in China, to estimate the prevalence of retropharyngeal lymph node (RPLN) in HPC, identify risk factors associated with RPLN metastasis and determine the prognostic implications of RPLN metastasis
We retrospectively examined patients from Jan 2010 to Dec 2018 diagnosed with non-distant metastasis hypopharyngeal squamous cell carcinoma (HPSCC), from three cancers from China: Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College; Sun Yat-sen University Cancer Center, the State Key Laboratory of Oncology in South China’s Collaborative Innovation Center of Cancer Medicine; and Harbin Medical University Cancer Hospital

Summary

Introduction

Among head and neck cancers, hypopharyngeal carcinoma (HPC) is most often detected at an advanced stage with poor prognosis, having 5 year survival rates of 31-47% [1,2,3]. Due to the abundant lymph flow from the HPC, about 70% of patients have already presented with cervical node metastasis at their initial diagnosis [3]. Retropharyngeal lymph node (RPLN) metastasis of HPC often receives less consideration than metastasis to lymph nodes in the neck. There are few published reports concerning the incidence and role of RPLN metastasis in HPC [4, 5]. Risk factors and prognostic significance of retropharyngeal lymph node (RPLN) metastasis diagnosed by magnetic resonance imaging (MRI) in patients with hypopharyngeal squamous cell carcinoma (HPSCC)

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